Causative factors for time delays in patients with acute st-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

Kim, Jeong Ai; Jeong, Jin Ok; Ahn, Kye Taek; Park, Hyung Seo; Jang, Won Il; Kim, Min Soo; Kim, Jun Hyung; Park, Jae Hyeong; Lee, Jae Hwan; Choi, Si Wan; Seong, In Whan

Abstract

BACKGROUND/AIMS
The time delay for a patient from the onset of disease symptoms until the reperfusion therapy is one of the biggest interruptions in early reperfusion therapy in patients with acute ST-segment elevation myocardial infarction (STEMI). Here, we evaluated both the duration and nature of these time delays to facilitate early patient reperfusion therapy.
METHODS
Patients with acute STEMI who were undergoing primary percutaneous coronary intervention (PCI) were prospectively enrolled in the Chungnam National University Hospital from January 2005 to December 2007.
RESULTS
From a total 364 patients (mean age: 64+/-12 years) the mean time interval from the onset of symptoms to the decision to visit a hospital was 101.4+/-10.6 (median: 50.0) minutes. The mean time interval for the onset of disease symptoms to the patient arrival at the emergency room (ER) (pre-hospital delay) was 222.1+/-12.4 (median: 171.5) minutes. The mean time interval from the ER to reperfusion (door to balloon time) was 89.0+/-6.0 (median 65.0) minutes. The mean time interval from the onset of symptoms to successful reperfusion therapy (pain to balloon time) was 311+/-13.6 (median: 250) minutes. The factors associated with these significant time delays were mainly: residency in rural areas, the use of private transport in preference to an ambulance and finally the transferal of patients from other hospitals. As a result of multivariate analysis the latter was found to be the most significant causative factor.
CONCLUSIONS
This study demonstrates that there is a significant pre-hospital time delay in patients with STEMI. Thus, a media campaign explaining STEMI symptoms, the importance of early visits to the emergency department, the use of an ambulance, and the activation of the base hospital for efficient patient transfer (particularly in rural areas) may reduce this time delay in patients with STEMI and avoid interruptions to otherwise efficient reperfusion therapies.